CN101043853B - Intramedullary pin for insertion in medullary cavity of femur - Google Patents

Intramedullary pin for insertion in medullary cavity of femur Download PDF

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Publication number
CN101043853B
CN101043853B CN2004800441899A CN200480044189A CN101043853B CN 101043853 B CN101043853 B CN 101043853B CN 2004800441899 A CN2004800441899 A CN 2004800441899A CN 200480044189 A CN200480044189 A CN 200480044189A CN 101043853 B CN101043853 B CN 101043853B
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intramedullary pin
hole
far
nail section
end nail
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CN2004800441899A
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CN101043853A (en
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托马斯·考普
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Synthes GmbH
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Synthes GmbH
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/7241—Intramedullary pins, nails or other devices with special means of locking the nail to the bone the nail having separate elements through which screws pass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7283—Intramedullary pins, nails or other devices with special cross-section of the nail
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/744—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to an intramedullary nail
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor

Abstract

The invention relates to an intramedullary pin (1) for insertion into the medullary space of a femur through the lateral compacta of the trochanta major. Said pin comprises a proximal pin section, an adjoining distal pin section and bores (2, 3, 4, 5, 6, 7, 8) for bone screws in both pin sections. The proximal pin section comprises at least one bore (3, 4) running obliquely to the longitudinal axis, so that bone screws can be introduced through said bore into the head of the femur, or a screw can be inserted in an antegrade direction through the bore (2). The distal pin section is at least partially vertical and the proximal pin section curves in a lateral-posterior direction.

Description

Be used to insert the intramedullary pin of femur bone marrow intracavity
Technical field
The present invention relates to a kind of intramedullary pin that is used to insert the femur bone marrow intracavity.
Background technology
In as the US6464360B1 of prior art, mainly disclosed a kind of intramedullary pin that is used for synthetism.The far-end of described intramedullary pin has a bending in front and back before in inserting femur on the plane, the described bending bending corresponding with femur conforms to.Its near-end has successive bending on the front, the radius of curvature of described bending is almost invariable.
Disclosed a kind of mixing nail in US6010506, described mixing nail has the different radius that in one plane extends.
In WO02089683, disclosed the spiral helicine geometry of nail.Adopt inlet point that this geometry realized being used for the nail that direct motion inserts from rotor-end moving laterally.When inserting nail, nail is rotated about 90 °.The rotation of nail mainly is subjected to the influence of its structure.Wherein Nei Bu medullary cavity wall and spongy bone plays a part guide frame.
But the variation owing to the skeleton dissection structure when the spiral helicine geometry of application of pure will cause puzzlement.Although arrived the final position sometimes, far-end bolt-lock hole and centre position, the misalignment outside.Nail further must be inserted or pulls back for revising.Therefore will cause nail to center on the rotation of its longitudinal axis.This point causes the height of bolt-lock position undesirable variation to occur.Therefore when arriving the final position, the screw that is used for carrying out bolt-lock on femoral head can not be inserted in the neck of femur from the center.When only rotation being revised, this point can cause the skew of the implantation depth of nail on the contrary again, causes the height of bolt-lock position undesirable variation to occur thus.If the near-end of nail is not positioned at skeleton as yet fully, then nail deeper must be inserted.But what this point will cause not wishing occurring is rotated further.Therefore best bolt-lock position can change again.
When being easy to act as most nail and being positioned at its final implantation depth scope, preferred far-end bolt-lock hole is parallel to the front or aims at centre position, the outside.Utilize screw that intramedullary pin is fixed in the near-end scope, described screw passes neck of femur and is placed in the femoral head.When bolt-lock, must guarantee the implantation depth of intramedullary pin, so that make screw pass neck of femur from the center.Yet neck of femur and femoral head are benchmark with the end face centers on the deflection of femur longitudinal axis.This deflection is known as top rake.This point causes the intramedullary pin must be around the deflection of its longitudinal axis so that adaptive with the top rake that changes because of anatomical structure is different, thereby realize screw from the center to neck of femur penetrate and capital intermediary fixing.The near-end of intramedullary pin should flush with cortex on every side in addition, perhaps is deeper than cortex.Tissue around this names a person for a particular job and is avoided is subjected to the stimulation of near-end intramedullary nail terminal.
Summary of the invention
Therefore the objective of the invention is to propose a kind of intramedullary pin, it needn't have adaptive geometry for the femur of every kind of special growth, thereby can satisfy above-mentioned condition.
The objective of the invention is to be achieved by remodeling to spiral helicine end.Wherein the near-end of intramedullary pin is crooked on a plane.It is straight that far-end then keeps.Therefore stop the rotation automatically in the time of in intramedullary pin arrives its final implantation depth scope.In final implantation depth scope, intramedullary pin can move at its longitudinal axis of situation lower edge that does not change position of rotation.And intramedullary pin still can rotate arbitrarily around its longitudinal axis, and can therefore not change its implantation depth.
Nail distal ports part at least is unbending at all, simultaneously when the nail distal ports is passed trochiterian side compacted zone and is inserted in the medullary cavity, follow closely proximal segment to the rear flank to stretching, extension.
Owing to changed spiral helicine end, thereby the implant of making is applicable to specific skeleton group best.The variation of anatomical structure no longer influences the function of implant.For being implemented in the bolt-lock on the skeleton, can carry out best orientation to implant.
Intramedullary pin of the present invention preferably has two and favours hole that being parallel to each other of the longitudinal axis stretch and the 3rd and described two first holes that the hole intersects in the near-end scope.The characteristics of this bolt-lock mode are multiple bolt-lock scheme is combined.In intramedullary pin of the present invention, the direct motion bolt-lock is very important.The new side tool mouth that is used to insert intramedullary pin almost overlaps with the placing direction of direct motion screw.If therefore only adopt a screw, then needn't on skin, have the other edge of a knife at near-end.
The far-end of intramedullary pin of the present invention preferably has two horizontal and be parallel to each other and stretch hole and holes that are arranged on the same extending transversely between described two holes, and the latter's hole is corresponding to being reversed around the longitudinal axis by the plane of described two holes definition.Intermediary bolt-lock screw is corresponding to 25 ° of settings of the bolt-lock screw rotation left side and the right.
The characteristics of this far-end bolt-lock are various bolt-lock schemes are combined.Except generally well-known standard latches, between two standard latches, also have the 3rd hole.Utilize three screws that the bolt-lock of intramedullary pin is realized the axially stable of intramedullary pin.That is to say that the end position of the far-end of intramedullary pin is fixed.Skew can not appear in intramedullary pin on screw.Because 25 ° of angles of axial latch screw dislocation, thereby avoided when inserting screw, being damaged to important soft tissue portion.When inserting above-mentioned situation will appear to (90 °) in front and back when screw for example.The about 30mm in bolt-lock screw space.
When implanting implant, intramedullary pin is connected with the target camber member.Described target camber member is flat on the end of intramedullary pin usually.Thereby transition and the profile of realizing the no step between intramedullary pin and the target camber member combine.
For realizing meeting the implantation that specialty requires, it is highly important that, can utilize formation method (x-ray fluoroscopy) to identify the end of nail clearly.This point can't be realized according to present prior art, or only can be not enough to realize with meeting the demands.Incorrect implantation depth will cause following consequence: when the degree of depth of intramedullary pin in skeleton is not enough, can bring out such as complication such as pain, necrosis owing to the intramedullary pin end of protruding.Implanted when dark at intramedullary pin, and can cause the skew of intramedullary pin end.Can cause also that in addition skeleton inwardly grows, thereby with original top closure of inserting passage.This names a person for a particular job to make and is difficult to afterwards implant is taken out.Also exist the tip of nail to penetrate the interior danger of knee in addition.
Preferably the arranged outside at the near-end of intramedullary pin of the present invention has the inclined-plane, and this inclined-plane will combine interruption to intramedullary pin with transition and profile between the target camber member.Therefore be convenient to identify clearly the end of nail when pickup image (x-ray fluoroscopy) in front and back.This point has been simplified operation, and uses saferly, and has shortened operating time.The intramedullary pin inlet point is positioned on the trochiterian side.This face can touch for thin patient especially.That is to say that this face only is coated with the thin skin layer of one deck.Because the inlet point of intramedullary pin is arranged on the side, thereby has avoided the stimulation of the end of intramedullary pin near-end to soft tissue portion.Therefore being also advantageous in that of this inclined-plane, the end that can realize the intramedullary pin near-end combines with the profile cooperation of spongy bone sidewall.Therefore can prevent stimulation to soft tissue.
Preferably on the median surface of the end of near-end, be provided with a groove, anti-the turning round of intramedullary pin be fixed on the target camber member by this groove.Opposite with the present invention, prior art realizes anti-turning round fixingly by two grooves, thereby certainly will increase manufacturing cost.
Be provided with at near-end columniform recessed, the mutual reverse axle of the attachment screw between target camber member and the intramedullary pin be placed into described recessed in.So intramedullary pin axle and arc target coaxial alignment, wherein screw thread only is used to produce extruding force.Different with the present invention, prior art directly and only realizes coaxial alignment by the screw thread of attachment screw.
According to a kind of special design, the tip has special structural design, thereby described tip can be in case be driven in the spongy bone in the distal femoral scope, so that still can realize anti-turn round fixing even without the screw bolt-lock with reversing.The radially section at intramedullary pin tip has non-circular special tip surface, particularly has recessed otch or plane.But according to these two kinds of flexible programs, can not replenish arbitrarily or non-arbitrarily the rotation.
In accompanying drawing and dependent claims, further design of the present invention is explained and described.
Described further design and Reference numeral synopsis are the ingredients of disclosure.
Description of drawings
The contrast accompanying drawing is described further visually and for example to the present invention below.
Below will be interrelated and be illustrated to accompanying drawing with being interweaved.
Shown in the figure:
Fig. 1 illustrates in the past to see backward and looks, i.e. intramedullary pin of the present invention on the side mid-plane,
Fig. 2 illustrates to see in the middle of the lateral and looks, i.e. intramedullary pin of the present invention on pro--back plane,
Fig. 3 illustrates from near-end and sees the intramedullary pin of looking of the present invention to far-end,
Fig. 4 a illustrates the special embodiment of the end of the intramedullary pin of the present invention of middle sight apparent time from the lateral,
Fig. 4 b illustrates from the special embodiment of far-end to the end of the intramedullary pin of the present invention of near-end sight apparent time,
Fig. 5 a illustrates the special embodiment of the end of the intramedullary pin of the present invention of middle sight apparent time from the lateral,
Fig. 5 b illustrates from the special embodiment of far-end to the end of the intramedullary pin of the present invention of near-end sight apparent time,
Fig. 6 a illustrates the special embodiment of the end of the intramedullary pin of the present invention of middle sight apparent time from the lateral,
Fig. 6 b illustrate from far-end see to near-end apparent time intramedullary pin of the present invention the end special embodiment and
Fig. 7 illustrates near-end from near-end to far-end that see the intramedullary pin of the present invention of apparent time from.
The specific embodiment
Fig. 1-3 illustrates intramedullary pin 1 of the present invention with three visual angles respectively.Proximal face and far-end end face reverse 60 °-110 ° mutually, preferably reverse 70 °-90 °, particularly reverse 80 °.According to present embodiment, radius is 300-1300mm, is preferably 900-1200mm, particularly is about 1100mm.The length of near-end radius is with corresponding to the side contacts face of cortex.This length is 300-1000mm, is preferably 600-800mm, in particular for 700mm.
The length of the straight portions of far-end equals the end of intra medullary nail far-end and stretches into the interior degree of depth of distal bone spongiosa structure.This length is 35-70mm, is preferably 40-60mm, particularly is about 52mm.
Be provided with in nail 1 near-end scope: one 120 ° direct motion hole 2 is used for the bolt-lock screw of 3.9-6.0mm thickness; Seek and visit hole 3 for 130 ° of a front, be used for the screw rod of about 6.5mm thickness, the described hole 3 of seeking and visiting overlaps with 120 ° of direct motion holes 2 of the bolt-lock screw that is used for the 3.9-6.0mm thickness middle; About 130 ° hole 4 of seeking and visiting of a back is used for the screw rod of about 6.5mm thickness; With elliptical aperture 5, be used for the bolt-lock screw of 3.9-6.0mm thickness is carried out static immobilization and Kinematic Positioning.This external near-end also is provided with skew back face 9.
At last be provided with two the horizontal hole 6 of stretching and 7 and front-side holes 8 of being parallel to each other at far-end, described hole 8 is with respect to 25 ° of the hole 6 of described extends parallel and 7 rotations.Described angle preferably (is equivalent to front or plane between two standard bolt-lock screws 0 ° the time) between 45 ° and 10 °.
Fig. 4 a and 4b are two views of flexible program at the tip of intramedullary pin 1 of the present invention.The radially section at described tip has non-circular special tip surface 13, particularly has three planes, and described planar length is 10-40mm, is preferably 15-25mm, in particular for 20mm.Most advanced and sophisticated total length is 20-50mm, is preferably 25-35mm, in particular for 30mm.Hole 7 also is shown in addition in the drawings.
Fig. 5 a and 5b are two views of flexible program at the tip of intramedullary pin 1 of the present invention.The radially section at described tip has non-circular special tip surface 13, particularly has three recessed otch, and the length of described otch is 10-40mm, be preferably 15-25mm, in particular for 20mm, its radius is 4-10mm, be preferably 5-8mm, in particular for 6mm.Most advanced and sophisticated total length is 20-50mm, is preferably 25-35mm, in particular for 30mm.Also show hole 7 in addition among the figure.
Fig. 6 a and 6b are two views of flexible program at the tip of intramedullary pin 1 of the present invention.The radially section at described tip has non-circular special tip surface 13, particularly has four recessed otch, and the length of described otch is 10-40mm, be preferably 15-25mm, particularly be about 20mm, its radius is 4-10mm, be preferably 5-8mm, particularly be about 6mm.Most advanced and sophisticated total length is 20-50mm, is preferably 25-35mm, particularly is about 30mm.Also show hole 7 in addition among the figure.
Fig. 7 shows near-end from near-end to far-end that see the intramedullary pin of the present invention 1 of apparent time from.Be provided with an inclined-plane 9 in the outside, the described inclined-plane 9 outside near-end is 10 ° to 60 ° with the angle of axial intramedullary pin axis, preferably is about 40 °.Show columniform recessed 12 and the locating slot on the medial side of near-end 10 at last with screw thread 11.
The Reference numeral table of comparisons
1 intramedullary nail
2 direct motion holes
3 front aperture
4 rear faces
5 elliptical apertures
6 holes parallel with 7
7 holes parallel with 6
8 front apertura lateralises
9 skew back faces
10 locating slots
11 screw threads
12 is cylindrical recessed
13 tip surfaces

Claims (8)

1. an intramedullary pin (1), be used for inserting in the medullary cavity of femur from greater trochanter side compacted zone, comprise: near-end nail section with proximal end face, the far-end nail section that is connected with near-end nail section with distal face, and the bone screw (2,3,4,5,6,7,8) in near-end nail section and far-end nail section, wherein said near-end nail section has at least one and favours the hole (3,4) that the longitudinal axis stretches, thereby making bone screw can penetrate described hole is placed in the femoral head
It is characterized in that described far-end nail section is straight to small part, described proximal end face and described distal face rotate 60 °-110 ° mutually, and described near-end nail section has a bending that makes progress in the rear flank.
2. intramedullary pin as claimed in claim 1 (1) is characterized in that, the length of described near-end nail section conforms to the side contacts face of cortex, and the radius of described near-end nail section is 300-1000mm.
3. intramedullary pin as claimed in claim 2 (1) is characterized in that, the radius of described near-end nail section is 600-800mm.
4. intramedullary pin as claimed in claim 3 (1) is characterized in that, the radius of described near-end nail section is 700mm.
5. intramedullary pin as claimed in claim 1 (1) is characterized in that, the length of the straight portions of described far-end equals under implanting state described far-end nail end and enters the degree of depth in the distal bone spongiosa structure, and the length of the straight portions of described far-end is 35-70mm.
6. intramedullary pin as claimed in claim 5 (1) is characterized in that,
The length of the straight portions of described far-end is 40-60mm.
7. intramedullary pin as claimed in claim 6 (1) is characterized in that,
The length of the straight portions of described far-end is 52mm.
8. intramedullary pin as claimed in claim 1 (1) is characterized in that, described intramedullary pin has following hole:
One 120 ° direct motion hole (2) is used for the bolt-lock screw of about 5.0mm thickness;
Seek and visit hole (3) for 130 ° of a front, be used for the screw rod of about 6.5mm thickness, the described hole (3) of seeking and visiting overlaps in the centre with described direct motion hole (2);
About 130 ° hole (4) of seeking and visiting of a back is used for the screw rod of 3.9-6.0mm thickness;
An elliptical aperture (5) is used for the bolt-lock screw of 3.9-6.0mm thickness is carried out static immobilization and Kinematic Positioning in the near-end scope;
Two horizontal and be parallel to each other and stretch other hole (6) and (7); And
One with respect to described two laterally and the preceding apertura lateralis (8) at far-end of 25 ° of other holes (6, the 7) rotations of stretching of being parallel to each other.
CN2004800441899A 2004-10-14 2004-10-20 Intramedullary pin for insertion in medullary cavity of femur Active CN101043853B (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US52256804P 2004-10-14 2004-10-14
US60/522,568 2004-10-14
PCT/IB2004/003425 WO2006040612A1 (en) 2004-10-14 2004-10-20 Intramedullary pin for insertion into the medullary space of a femur

Publications (2)

Publication Number Publication Date
CN101043853A CN101043853A (en) 2007-09-26
CN101043853B true CN101043853B (en) 2010-09-29

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US (3) US8317788B2 (en)
EP (1) EP1802243B1 (en)
JP (1) JP4681613B2 (en)
KR (1) KR101230768B1 (en)
CN (1) CN101043853B (en)
AU (1) AU2004323972A1 (en)
BR (1) BRPI0419194B8 (en)
CA (1) CA2584125C (en)
NZ (1) NZ554377A (en)
TW (1) TW200630067A (en)
WO (1) WO2006040612A1 (en)
ZA (1) ZA200702456B (en)

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